Transcranial Doppler Sonography is Useful for the Decision-Making at the Point of Care in Patients with Acute Hepatic Failure: A Single Centre’s Experience

• Published in: Journal of clinical monitoring and computing Vol. 22; no. 6; pp. 449 - 452
• Main Authors: Bindi, M. L., Biancofiore, G., Esposito, M., Meacci, L., Bisà, M., Mozzo, R., Urbani, L., Catalano, G., Montin, U., Filipponi, F.
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2008; Springer; Springer Nature B.V
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Brain Ischemia - diagnostic imaging; Brain Ischemia - etiology; Clinical death. Palliative care. Organ gift and preservation; Critical Care Medicine; Decision Support Systems, Clinical; Decision Support Techniques; Female; Health Sciences; Humans; Image Interpretation, Computer-Assisted - methods; Intensive; Intensive care medicine; Liver Failure, Acute - complications; Liver Failure, Acute - diagnostic imaging; Male; Medical sciences; Medicine; Medicine & Public Health; Point-of-Care Systems; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Statistics for Life Sciences; Ultrasonography, Doppler, Transcranial - methods; acute hepatic failure; Doppler ultrasound; point-of-care technology; neurological examination; neurological disorder; Doppler ultrasound study; Sonography; Human; Nervous system diseases; Intensive care; Decision making; Hepatic disease; Liver failure; Digestive diseases; Neurological disorder; Ultrasound; Resuscitation
• ISSN: 1387-1307; 1573-2614; 1573-2614
• DOI: 10.1007/s10877-008-9156-6

Acute hepatic failure (ALF) is an uncommon disease characterized by a rapid deterioration of the hepatic function with severe derangements of the mental status in previously healthy subjects due to massive hepatocytes necrosis. Neurological impairment, due to intracranial hypertension and cerebral ischemia, is a key factor because it is a main criterion to decide when to proceed to liver transplantation, which is only treatment for these patients. Therefore, neurological monitoring holds an essential role in the clinical management of ALF patients but it needs to be performed at the point-of-care in the majority of the cases as such critically ill patients cannot be moved away from the ICU because they frequently need continuous hemodynamic, ventilatory and renal support. We herein report and discuss our experience relating to the use of transcranial sonography as a neuro-monitoring tool in ALF patients. In our series this technique allowed a repeatable and reliable non-invasive assessment of cerebral blood flow changes at the bedside thus avoiding the complications associated with the use of an intracranial probe to measure intra-cranial pressure and making it possible to correctly evaluate the timing and feasibility of liver transplantation.